Monday, December 19, 2011

ΩAlthough the study was done in rats, scientists suggest the findings could help explain why many users of the therapy report health benefits

Acupuncture significantly reduces levels of a protein in rats linked to chronic stress, researchers at Georgetown University Medical Center (GUMC) have found. They say their animal study may help explain the sense of well-being that many people receive from this ancient Chinese therapy.

Published online in December in Experimental Biology and Medicine, the researchers say that if their findings are replicated in human studies, acupuncture would offer a proven therapy for stress, which is often difficult to treat.

"It has long been thought that acupuncture can reduce stress, but this is the first study to show molecular proof of this benefit," says the study's lead author, Ladan Eshevari, Ph.D., an assistant professor at Georgetown's School of Nursing & Health Studies, a part of GUMC.

Eshkevari, who is also a nurse anesthetist as well as a certified acupuncturist, says she conducted the study because many of the patients she treats with acupuncture in the pain clinic reported a "better overall sense of wellbeing — and they often remarked that they felt less stress."

While traditional Chinese acupuncture has been thought to relieve stress —in fact, the World Health Organization states that acupuncture is useful as adjunct therapy in more than 50 disorders, including chronic stress — Eshevari says that no one has biological proof that it does so.

So she designed a study to test the effect of acupuncture on blood levels of neuropeptide Y (NPY), a peptide that is secreted by the sympathetic nervous system in humans. This system is involved in the "flight or fight" response to acute stress, resulting in constriction of blood flow to all parts of the body except to the heart, lungs, and brain (the organs most needed to react to danger). Chronic stress, however, can cause elevated blood pressure and cardiac disease.

Eshevari used rats in this study because these animals are often used to research the biological determinants of stress. They mount a stress response when exposed to winter-like cold temperatures for an hour a day.

Eshevari allowed the rats to become familiar with her, and encouraged them to rest by crawling into a small sock that exposed their legs. She very gently conditioned them to become comfortable with the kind of stimulation used in electroacupuncture — an acupuncture needle that delivers a painless small electrical charge. This form of acupuncture is a little more intense than manual acupuncture and is often used for pain management, she says, adding "I used electroacupuncture because I could make sure that every rat was getting the same treatment dose."

She then selected a single acupuncture spot to test: Zuslanli (ST 35 on the stomach meridian), which is said to help relieve a variety of conditions including stress. As with the rats, that acupuncture point for humans is on the leg below the knee.

The study utilized four groups of rats for a 14-day experiment: a control group that was not stressed and received no acupuncture; a group that was stressed for an hour a day and did not receive acupuncture; a group that was stressed and received "sham" acupuncture near the tail; and the experimental group that were stressed and received acupuncture to the Zuslanli spot on the leg.

She found NPY levels in the experimental group came down almost to the level of the control group, while the rats that were stressed and not treated with Zuslanli acupuncture had high levels of the protein.

In a second experiment, Eshevari stopped acupuncture in the experimental group but continued to stress the rats for an additional four days, and found NPY levels remained low. "We were surprised to find what looks to be a protective effect against stress," she says.

Eshevari is continuing to study the effect of acupuncture with her rat models by testing another critical stress pathway. Preliminary results look promising, she says.

Wednesday, December 14, 2011

When you cut an apple and leave it out, it turns brown. Squeeze the apple with lemon juice, an antioxidant, and the process slows down.

Simply put, that same "browning" process-known as oxidative stress-happens in the brain as Alzheimer's disease sets in. The underlying cause is believed to be improper processing of a protein associated with the creation of free radicals that cause oxidative stress.

According to the Alzheimer's Society, more than 5 million Americans currently suffer from the neurodegenerative disease. Without successful prevention, almost 14 million Americans will have Alzheimer's by 2050, accounting for healthcare costs of more than $1 trillion a year.

Oxidative stress is believed to cause neurons in the brain to die, resulting in Alzheimer's. Study author James Franklin, an associate professor of pharmaceutical and biomedical sciences, has studied neuronal cell death and oxidative stress at UGA since 2004.

"The brain consumes 20 percent of the oxygen in the body even though it only makes up 5 percent of the volume, so it's particularly susceptible to oxidative stress," said Franklin, coauthor of the study along with Meagan McManus, who received her Ph.D. in neuroscience from UGA in 2010.

The UGA researchers hypothesized that antioxidants administered unsuccessfully by other researchers to treat Alzheimer's were not concentrated enough in the mitochondria of cells. Mitochondria are structures within cells that have many functions, including producing oxidative molecules that damage the brain and cause cell death.

"MitoQ selectively accumulates in the mitochondria," said McManus, who is now studying mitochondrial genetics and dysfunction as a postdoctoral researcher at Children's Hospital of Philadelphia.

"It is more effective for the treatment to go straight to the mitochondria, rather than being present in the cell in general," she said.

Although he had not previously conducted research on Alzheimer's disease, Franklin was moved to approve McManus' research proposal to take his laboratory research in a more clinical direction in part because of her family's history with the disease.

"Two of my grandparents had Alzheimer's disease, but they presented with it very differently. While my granddad often couldn't remember who we were, he was still the same soulful funnyman I'd always loved. But the disease changed my grandmother's mind in a different way, and turned her into someone we'd never known," said McManus.

"So the complexity of the disease was most intriguing to me. I wanted to know how and why it was happening, and more importantly, how to stop it from happening to other people," she said.

In their study, mice engineered to carry three genes associated with familial Alzheimer's were tested for cognitive impairment using the Morris Water Maze, a common test for memory retention. The mice that had received MitoQ in their drinking water performed significantly better than those that didn't. Additionally, the treated mice tested negative for the oxidative stress, amyloid burden, neural death and synaptic loss associated with Alzheimer's.

Guidelines for clinical management of patients with low back pain (LBP) encourage health care practitioners to advise staying active and returning to work. Despite this, most practitioners believe work factors can cause or exacerbate LBP, and a recommendation for a "short break from work" to allow healing is common. A new study in the December issue of Pain by researchers from the Department of Psychology, Royal Holloway, University of London finds that practitioners perceive their role in returning patients to work as limited, and believe that at least some aspects of work are detrimental to patients' recovery.

"Low back pain is consistently among the top most costly health problems. Back pain has been identified as the second main cause of absenteeism in the UK. Our findings suggest that, despite guidelines that encourage maintaining people at work during episodes of back pain, many clinicians hold a range of beliefs that contradict this advice, and these beliefs can influence their clinical decisions and behaviors," explains lead author Professor Tamar Pincus, PhD.

Researchers measured work-related behaviors and beliefs related to low back pain among osteopaths, physiotherapists, and chiropractors across the UK. After general practitioners, these three groups most commonly treat LBP in the UK. The authors measured how frequently these practitioners visited a patient's workplace, provided sick leave certificates, recommended a break from work for recovery, and prescribed exercises that could be incorporated into the patient's work routine. The Attitudes to Back Pain Scale for musculoskeletal practitioners was included to explore the relationship between general beliefs about back pain and work-related behaviors, such as whether the practitioner limits the number of sessions for the treatment of low back pain, and believes that increasing mobility should be a goal of treatment. Finally, the authors examined practitioners' beliefs about: the benefit vs. threat of work to health in general and back pain in particular; the work-related roles of musculoskeletal practitioners; the need for patients to take a short break to recover from LBP; and practitioners' perception of employers' willingness to help patients with LBP.

Advising patients to take work absence was extremely common. Eighty percent of respondents reported recommending work absence to patients with LBP sometimes, and an additional 13% reported that they do so often or always. While 70% of practitioners never visited the workplace to advise and prescribe ergonomic changes, investigators found that a common practice was the prescription of exercises that could be incorporated into the work routine, with 83% reporting that they do so always or often. Although it was common to recommend a short break from work, less than 2% of respondents prescribed sick leave certification for LBP often or always.

Physiotherapists, who in the UK are employed by the National Health Service, more strongly endorsed the benefits of work to aid in recovery from LBP than either osteopaths or chiropractors, who typically work in the private sector. Physiotherapists also agreed significantly less with the notion that work can either cause or exacerbate pain, and they tended to endorse limiting the number of treatment sessions for LBP.

Reports of visiting the workplace directly and contacting employers to allow for coordinated action to support people staying at work during LBP were extremely low in this study. "Integrated care at work has shown promising results in earlier clinical trials. If return to work is beneficial to patients and is a primary goal for cost savings, bringing these practitioners on board and altering their perceptions of the individual-employer-clinician triad is important," says Dr. Pincus.

###The article is "Advising people with back pain to take time off from work: A survey examining the role of private musculoskeletal practitioners in the UK," by T. Pincus, L. Greenwood, and E. McHarg (DOI: 10.1016/j.pain.2011.09.010). It appears in Pain, Volume 152, Issue 12 (December 2011) published by Elsevier.

Tuesday, December 6, 2011

Acupuncture for chemotherapy-induced peripheral neuropathy: A pilot study using neurography

Acupuncture may help ease the severe nerve pain associated with certain cancer drugs, suggests a small preliminary study published in Acupuncture in Medicine.

Cancer patients treated with taxanes, vinca alkaloids, or platinum compounds can develop a condition known as chemotherapy induced peripheral neuropathy, or CIPN for short, as a by-product of their treatment. These powerful drugs can damage peripheral nerves, particularly in the calves and feet, which can result in severe nerve pain and/or difficulty walking. As yet, there is no effective antidote.

Out of a total of 192 patients with peripheral neuropathy eligible for inclusion in the study, 11 had developed their symptoms during a course of chemotherapy for various types of cancer. Six of these patients agreed to undergo acupuncture; the other five served as a comparison group.

Twenty needles were inserted at prescribed points and depths and left in place for 20 minutes during each of the 10 sessions. These were delivered over a period of three months by a senior doctor, who had been fully trained in acupuncture and had used the technique for 20 years.

Nerve conduction studies, to assess the signalling speed and intensity of two nerves in the same calf were carried out before acupuncture and again six months after chemotherapy in the six volunteers. The same studies on patients in the comparison group were carried out after they had completed their chemotherapy and then again six months later.

At the second neurological assessment, patients in both groups were asked to state whether they thought their condition had changed or stayed the same.

Clinical examination showed that all the patients had a mixture of numbness on touch and nerve pain, while nerve conduction studies showed evidence of damage to the sural nerve.

In those given acupuncture, both the speed and the intensity of the nerve signalling improved in five out of the six patients. And these same patients said their condition had improved. Among those in the comparison group, speed remained the same in three, fell in one, and improved in one. Intensity remained the same in one, improved in two, and decreased in two.

The authors point to previous research, which suggests that acupuncture may boost blood flow in the legs, which may in turn aid the repair of nerve damage.

"The data suggest that acupuncture has a positive effect on CIPN, as measured by objective parameters [nerve conduction studies]," write the authors, adding that their results are similar to those found in patients with nerve damage caused by diabetes and those with peripheral neuropathy of unknown cause.

They conclude that the results of this pilot study are "encouraging," and merit further investigation in a larger trial.

Monday, November 21, 2011

Experienced meditators seem to be able switch off areas of the brain associated with daydreaming as well as psychiatric disorders such as autism and schizophrenia, according to a new brain imaging study by Yale researchers.

Meditation's ability to help people stay focused on the moment has been associated with increased happiness levels, said Judson A. Brewer, assistant professor of psychiatry and lead author of the study published the week of Nov. 21 in the Proceedings of the National Academy of Sciences. Understanding how meditation works will aid investigation into a host of diseases, he said.

"Meditation has been shown to help in variety of health problems, such as helping people quit smoking, cope with cancer, and even prevent psoriasis," Brewer said.

The Yale team conducted functional magnetic resonance imaging scans on both experienced and novice meditators as they practiced three different meditation techniques.

They found that experienced meditators had decreased activity in areas of the brain called the default mode network, which has been implicated in lapses of attention and disorders such as anxiety, attention deficit and hyperactivity disorder, and even the buildup of beta amyloid plaques in Alzheimer's disease. The decrease in activity in this network, consisting of the medial prefrontal and posterior cingulate cortex, was seen in experienced meditators regardless of the type of meditation they were doing.

The scans also showed that when the default mode network was active, brain regions associated with self-monitoring and cognitive control were co-activated in experienced meditators but not novices. This may indicate that meditators are constantly monitoring and suppressing the emergence of "me" thoughts, or mind-wandering. In pathological forms, these states are associated with diseases such as autism and schizophrenia.

The meditators did this both during meditation, and also when just resting — not being told to do anything in particular. This may indicate that meditators have developed a "new" default mode in which there is more present-centered awareness, and less "self"-centered, say the researchers.

"Meditation's ability to help people stay in the moment has been part of philosophical and contemplative practices for thousands of years," Brewer said. "Conversely, the hallmarks of many forms of mental illness is a preoccupation with one's own thoughts, a condition meditation seems to affect. This gives us some nice cues as to the neural mechanisms of how it might be working clinically."

Wednesday, November 16, 2011

With record levels of student stress reported in a recent UCLA survey, can a simple stress-reducing meditation technique be a viable solution?

A new study published in the Journal of Instructional Psychology found the Transcendental Meditation (TM) technique significantly decreased psychological distress in public school students. The study, conducted with at-risk minority secondary school students, showed a 36 percent reduction in overall psychological distress. Significant decreases were also found in trait anxiety and depressive symptoms.Rising Stress Levels Affect Emotional and Physical Health

The percentage of students in the UCLA survey reporting good or above-average high school emotional health dropped from 55.3 percent in 2009 to 51.9 percent in 2010. This marks the lowest level within the past 25 years.

Dr. Charles Elder, MD, lead author of the TM study, and investigator at Kaiser Permanente Center for Health Research, emphasized the important implications of the findings on reduced stress. "It is vital that we start addressing the high levels of emotional stress being reported by high school and college students. Decreased stress can have a positive impact on mental health, and can also reduce the risk for hypertension, obesity, and diabetes—major risk factors for heart disease," explained Dr. Elder.

Educational research has also linked student stress to negative school behavior and poor academic performance.Promising Findings for Education

"These new findings on reduced stress, along with the recent research on academic achievement gains, hold tremendous promise for public education," said Sanford Nidich, EdD, principal investigator, and professor of education at Maharishi University of Management. "There is a growing body of evidence showing Transcendental Meditation to be an easy to implement, value-added educational program that promotes emotional health and increases academic achievement in at-risk students," said Dr. Nidich.

A total of 106 secondary school students, 87% racial and ethnic minorities, took part in the study. Results showed that over a four-month period, students practicing Transcendental Meditation as part of their schools' Quiet Time program exhibited significant reductions in psychological distress factors compared to controls.

According to James Dierke, 2008 National Association of Secondary School Principals—National Middle School Principal of the Year, "Stress is the number one enemy of public education, especially in inner-city schools. It creates tension, violence, and compromises the cognitive and psychological capacity of students to learn and grow. The TM/Quiet Time program is the most powerful, effective program I have come across in my 39 years as a public school educator for addressing this problem. It is nourishing children and providing them an immensely valuable tool for life. It is saving lives."

Study Facts

• This study evaluated change in psychological distress factors in students practicing the Transcendental Meditation program compared to non-meditating controls. A total of 106 students (68 meditating and 38 non-meditating students), took part in the study. The study included students from four public secondary schools.• Eighty-seven percent were racial and ethnic minority students, including 26% Hispanic, 25% African American, and 19% American Indian.• The Transcendental Meditation program was practiced in class twice a day as part of the schools' Quiet Time program for four months prior to posttesting.• The Transcendental Meditation program was taught in the context of school-wide Quiet Time programs in which students voluntarily chose the Quiet Time program in which they wanted to participate.• Transcendental Meditation is a simple, natural, effortless technique that allows the mind to settle down and experience a silent yet awake state of awareness, a state of "restful alertness." Practice of this stress-reduction program does not involve any change in beliefs, values, religion, or lifestyle.• Compared to eyes-closed rest, research has found that Transcendental Meditation practice is characterized by decreased activation or arousal of the autonomic nervous system, as reflected in decreased breath rate and lower sympathetic nervous system activity. The Transcendental Meditation program has been shown to increase electroencephalographic (EEG) brain integration and coherence, especially in the frontal area of the brain, responsible for higher-order processing.• Other published research on high school and college students has shown reduced psychological distress, improved positive coping ability, decreased blood pressure, reduced cardiovascular reactivity to stressful stimuli, reduced absenteeism, and decreased school suspensions.• Results of the current study indicated significant reductions in overall psychological distress (p=.010) and trait anxiety (p=.035) compared to controls. Within-in group differences in depressive symptoms were found for meditating students (p=.003).

Thursday, November 10, 2011

When given alongside radiation therapy for head and neck cancer, acupuncture has shown for the first time to reduce the debilitating side effect of xerostomia, according to new research from The University of Texas MD Anderson Cancer Center and Fudan University Shanghai Cancer Center.

The study, published in the journal Cancer, reported findings from the first randomized controlled trial of acupuncture for the prevention of xerostomia.

Xerostomia, or severe dry mouth, is characterized by reduced salivary flow, which commonly affects patients receiving radiotherapy for head and neck cancer. Most current treatments are palliative and offer limited benefit, according to Lorenzo Cohen, Ph.D., professor in MD Anderson's Departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program.

The condition impairs quality of life for patients, as it creates difficulties eating, speaking and sleeping, while also increasing the risk for oral infections.

"There have been a number of small studies examining the benefits of acupuncture after xerostomia develops, but no one previously examined if it could prevent xerostomia," said Cohen, who is also the study's principal investigator. "We found incorporating acupuncture alongside radiotherapy diminished the incidence and severity of this side effect."

Cohen and his colleagues examined 86 patients with nasopharyngeal carcinoma, treated at Fudan University Shanghai Cancer Center. Forty patients were randomized to acupuncture and 46 to the standard of care. Those in the treatment arm received acupuncture therapy three times per week during the seven-week course of radiotherapy. Patients were evaluated before radiotherapy, weekly during radiotherapy, and then again one and six months later.

The results were based on data derived from two self-report questionnaires and measuring actual saliva flow. Patients completed the Xerostomia Questionnaire (XQ), an eight-item survey which assessed symptoms consistent with the condition. XQ scores under 30 corresponded to mild or no symptoms of xerostomia.

The second measure, MD Anderson Symptom Inventory Head and Neck (MDASI-HN), ranked the severity of cancer-related symptoms, other than xerostomia, and their interference with quality of life. The team also measured saliva flow rates using standardized sialometry collection techniques.

Benefits Noticed Quickly

"What was quite remarkable was that we started to see group differences as early as three weeks into radiotherapy for the development of xerostomia, cancer-related symptoms that interfere with quality of life, and saliva flow rates - an important objective measure," said Zhiqiang Meng, M.D., Ph.D., co-principle investigator of the study and deputy chair of the Department of Integrative Oncology, Fudan University Shanghai Cancer Center.

The largest group differences in XQ scores were seen by the end of radiotherapy, but the differences persisted over time. By one month after the end of radiotherapy, 54.3 percent of the acupuncture group reported XQ scores greater than 30, compared to the control group at 86.1 percent. By six months after radiotherapy, the numbers dropped to 24.1 percent in the acupuncture group and 63.6 percent of the control group still reporting symptoms of xerostomia. Saliva flow rates were also greater in the acupuncture group, starting at three weeks into radiotherapy and persisting through the one and six month follow-up.

Acupuncture also helped cancer-related symptoms, other than xerostomia, as measured by the MDASI-HN questionnaire, with differences that emerged in week three and continued through six months.

"The medical implications are quite profound in terms of quality of life, because while chronic dry mouth may sound benign, it has a significant impact on sleeping, eating and speaking," Cohen said. "Without saliva, there can be an increase in microbial growth, possible bone infection and irreversible nutritional deficits."

Additional studies are needed to determine the mechanisms for the benefits of acupuncture, and while the study didn't examine this issue, Cohen said it may have an impact on local blood flux, specifically at the parotid gland.

Further research is planned, including a large trial conducted at MD Anderson in collaboration with Fudan University Shanghai Cancer Center. Both centers will enroll 150 patients undergoing radiotherapy for head and neck cancer: 50 will receive acupuncture, 50 sham acupuncture and 50 will be enrolled in a control group. Researchers will also examine saliva constituents and a number of other measures to better determine the mechanisms of acupuncture.

Monday, October 24, 2011

Yoga classes were found to be more effective than a self-care book for patients with chronic low back pain at reducing symptoms and improving function, but they were not more effective than stretching classes, according to a study published Online First by the Archives of Internal Medicine.

"Despite the availability of numerous treatments for chronic back pain, none have proven highly effective, and few have been evaluated for cost-effectiveness," the authors provide as background information. "Self-management strategies, like exercise, are particularly appealing because they are relatively safe, inexpensive, and accessible and may have beneficial effects on health beyond those for back pain. One form of exercise with at least 'fair' evidence for effectiveness for back pain is yoga, which might be an especially promising form of exercise because it includes a mental component that could enhance the benefits of its physical components."

Karen J. Sherman, Ph.D., M.P.H., from Group Health Research Institute, Seattle, and colleagues designed a study to determine whether yoga is more effective than conventional stretching exercises or a self-care book for primary care patients with chronic low back pain. A total of 228 adults with chronic low back pain were randomized to 12 weekly yoga classes (92 patients) or conventional stretching exercise classes (91 patients), or a self-care book that provided information on causes of back pain and advice on exercising, lifestyle modifications and managing flare-ups (45 patients). The main outcomes measured were back-related functional status and how much the back pain was bothering the patients. Telephone interviews were conducted at baseline, and at six, 12, and 26 weeks after randomization.

"Back-related dysfunction declined over time in all groups," the authors report. Compared with the self-care group, the yoga group reported superior function at 12 and 26 weeks (average difference, -2.5 and -1.8, respectively) and the stretching group reported superior function at six, 12 and 26 weeks (-1.7, -2.2, -1.5, respectively). "There were no statistically or clinically significant differences between the yoga and stretching groups" at any time point, the authors note.

"We found that physical activity involving stretching, regardless of whether it is achieved using yoga or more conventional exercises, has moderate benefits in individuals with moderately impairing low back pain. Finding similar effects for both approaches suggests that yoga's benefits were largely attributable to the physical benefits of stretching and strengthening the muscles and not to its mental components." The benefits of these approaches may last several months, the authors conclude.

In an accompanying commentary, Timothy S. Carey, M.D., M.P.H., from Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, writes, "The study by Sherman et al in this issue is an excellent example of a pragmatic comparative effectiveness trial."

"This research now represents best evidence for stretching therapies. Support by payers for these therapies will be very helpful through partial financial support for the classes. Such support will encourage patients to utilize the classes, representing a value-based reimbursement policy."

"We physicians should refer our patients for exercise, practitioners should work to standardize treatments, and payers should encourage these treatments through minimization of copayments for therapies that have both effectiveness and modest cost. Comparative effectiveness research, when well conducted, can assist us in making these clinical and policy recommendations."

Friday, October 14, 2011

A new study suggesting that "the role of the physician gatekeeper in regard to physical therapy may be unnecessary in many cases" could have significant implications for the US health care system, says the American Physical Therapy Association (APTA).

The study, published ahead of print September 23 in the journal Health Services Research (HSR), reviewed 62,707 episodes of physical therapy using non-Medicare claims data from a Midwest insurer over a 5-year period. Patients who visited a physical therapist directly for outpatient care (27%) had fewer visits and lower overall costs on average than those who were referred by a physician, while maintaining continuity of care within the overall medical system and showing no difference in health care use in the 60 days after the physical therapy episode.

The study is noteworthy because services delivered by physical therapists account for "a significant portion" of outpatient care costs in the United States, according to the study, and some health insurance plans require a physician referral for reimbursement of these services. In addition, although 46 states and the District of Columbia now allow some form of direct access to physical therapists, some of them nonetheless impose restrictions if patients have not been referred by a physician.

"Physical therapists have long known that direct access to our services is safe and effective," said APTA President R. Scott Ward, PT, PhD. "The elimination of referral requirements and other restrictions has been a priority of APTA for decades. This study provides further evidence that direct access to physical therapists could go a long way toward helping to make health care more affordable and accessible for all. We encourage researchers and insurers to continue to further investigate this important issue that could have a profound impact on patient care."

"When patients choose direct access to a physical therapist, it does not mean the end of collaboration with their physician, nor does it diminish continuity of care," added Thomas DiAngelis, PT, DPT, president of APTA's Private Practice Section. "We believe the results of this study will support our efforts to work with legislators and physician groups to establish policies that reduce unnecessary regulations, improve access, and build models of delivery that best serve the patient and the health care system. Although this study focused on direct access, it is not about the provider. It is about the patient. It means better opportunities to provide the proper care to those who need it, when they need it."

Led by Jane Pendergast, PhD, professor of biostatistics and director of the Center for Public Health Studies at the University of Iowa, the study retrospectively analyzed 5 years (2003-2007) of private health insurance claims data from a Midwest insurer on beneficiaries aged 18-64 in Iowa and South Dakota. A total of nearly 63,000 outpatient physical therapy episodes of care were analyzed – more than 45,000 were classified as physician-referred and more than 17,000 were classified as "self-referred" to physical therapists. Physical therapy episodes began with the initial physical therapist evaluation and ended on the last date of services before 60 days of no further visits. Episodes were classified as physician-referred if the patient had a physician claim from a reasonable referral source in the 30 days before the start of physical therapy. Researchers found that self-referred patients had fewer physical therapy visits (86% of physician-referred) and lower allowable amounts ($0.87 for every $1.00 of physician-referred) during the episode of care, after adjusting for age, gender, diagnosis, illness severity, and calendar year. In addition, overall related health care use – or care related to the problem for which physical therapy was received, but not physical therapy treatment – was lower in the self-referred group after adjustment. Examples of this type of care might include physician services or diagnostic testing. Potential differences in functional status and outcomes of care were not addressed.

"Health care use did not increase in the self-referred group, nor was continuity of care hindered," the researchers write. "The self-referred patients were still in contact with physicians during and after physical therapy. Concerns about patient safety, missed diagnoses, and continuity of care for individuals who self-refer may be overstated."

According to Rick Gawenda, PT, president of APTA's Section on Health Policy and Administration, the study should cause insurers and policymakers to rethink the physician gatekeeper concept when it comes to physical therapist services. "Evidence shows that, in the case of physical therapy, the physician gatekeeper model is doing exactly the opposite of what it was originally designed to do; it does not reduce ineffective and duplicate care nor reduce health care costs," says Gawenda. "It's time to end the physician referral requirement in every state, and it's time for all payers to embrace direct access to physical therapists."

Earlier research has supported direct access to physical therapists, but the new HSR study is the most comprehensive to date. A 1994 study analyzed 4 years of Blue Cross Blue Shield of Maryland claims data and found that total paid claims for physician referral episodes to physical therapists were 2.2 times higher than the paid claims for direct access episodes. In addition, physician referral episodes were 65% longer in duration than direct access episodes and generated 67% more physical therapy claims and 60% more office visits. The HSR study looked at a far more extensive number of episodes than the previous study, and also controlled for illness severity and other factors that could have affected the patients' outcomes.

"In summary," the researchers write, "our findings do not support the assertion that self-referral leads to overuse of care or discontinuity in care, based on a very large population of individuals in a common private health insurance plan with no requirement for PT [physical therapy] referral or prohibition on patient self-referral. We consistently found lower use in the self-referral group, after adjusting for key demographic variables, diagnosis group, and case mix. We also found that individuals in both groups were similarly engaged with the medical care system during their course of care and afterwards."

Tuesday, October 11, 2011

Ginger supplements reduced markers of colon inflammation in a select group of patients, suggesting that this supplement may have potential as a colon cancer prevention agent, according to a study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

Suzanna M. Zick, N.D., M.P.H., a research assistant professor at the University of Michigan Medical School, and colleagues enrolled 30 patients and randomly assigned them to two grams of ginger root supplements per day or placebo for 28 days.After 28 days, the researchers measured standard levels of colon inflammation and found statistically significant reductions in most of these markers, and trends toward significant reductions in others.

Inflammation has been implicated in prior studies as a precursor to colon cancer, but another trial would be needed to see how ginger root affects that risk, Zick said.“We need to apply the same rigor to the sorts of questions about the effect of ginger root that we apply to other clinical trial research,” she said. “Interest in this is only going to increase as people look for ways to prevent cancer that are nontoxic, and improve their quality of life in a cost-effective way.”

Zick is a naturopathic doctor (N.D.), which is a four-year degree that supplements a traditional medical education with instruction on the proper use of natural therapies, diet, nutrition and other alternative treatments. Her program is one of eight in the country, compared with about 135 traditional medical schools.

Wednesday, September 21, 2011

Mood disorders are among the most prevalent mental health issues today. While medication is available, more and more people are turning to complementary and alternative medicine (CAM), including herbal remedies, acupuncture, and meditation to help manage their mood disorders.

Andrew Newberg, MD, director of Research,Daniel Monti, MD, medical and executive director and Aleeze Moss, PhD, instructor of the Mindfulness-Based Art Therapy program at the Jefferson-Myrna Brind Center of Integrative Medicine at Thomas Jefferson University Hospital review the most commonly used CAM practices in the management of patients with mood disorders and the available data on CAM use for mood disorders in the recent issue of Expert Reviews in Neurotherapeutics.

Mood and anxiety disorders include a broad range of diagnoses such as major depression; dysthymia, a type of mild depression, and others.

A 2007 National Health Interview Survey (NHIS) showed that almost 40 percent of adults use CAM, with Americans with depression more likely to use CAM remedies than conventional antidepressants or psychotherapy.

Newberg, Monti and Moss evaluated CAM modalities across four categories: natural products; mind-body medicine and manipulative and body-based practices; and other CAM practices. A snapshot of their findings is outlined here:

Natural Products

Botanical medicines, vitamins, minerals and natural products found to positively impact patients with mood disorders, include: Hypericum (St. John’s Wort); S-adenosyl-methionine- an amino acid essential in production and delivery of dopamine, serotonin and norepenephrine throughout the brain; Omega-3 fatty acids- essential fatty acids (EFAs) play a role in maintaining brain structure and function. Research shows that reduced levels of EFAs may be associated with depression. The most common source of EFAs is fish oil.Mind-body practices

Meditation, yoga, qi-gong, tai-chi and acupuncture are among the most commonly used. Yoga is effective in improving anxiety and depression, suggests a growing body of research; Meditation-based practices such as mindfulness-based stress reduction and mindfulness-based cognitive therapy have supporting data suggesting therapeutic benefit, including decreases in depression, anxiety and distress for a variety of health conditions, including mood disorders; Acupuncture- inconclusive evidence shows acupuncture can be a beneficial treatment modality for mood disorders.Other CAM products

There are several CAM products that are used for mood disorders, but many have little supporting data. A few that do include: TRP and 5-HTP, amino acid precursors of serotonin, and the botanical Rhodiola rosea.The popularity of CAM interventions within the general Western population continues to grow as does the body of rigorous research into the effects and mechanisms of CAM interventions for mood disorders.

“As the field grows, we anticipate that the data will be able to provide a more detailed evaluation of CAM interventions with more practical applications regarding potential benefit effects and helping to avoid adverse effects,” conclude Drs. Newberg and Monti and Moss.Editor’s Note: Click here to view today’s Jefferson University

Friday, August 19, 2011

U.S. health care workers, especially doctors and nurses, use complementary and alternative medicine (CAM) far more than do workers in other fields, according to a new study. CAM includes diverse therapies outside the realm of conventional medicine. Overall, 76 percent of health care workers report CAM usage, compared with 63 percent of the general working population.

Health care workers use chiropractic treatment, massage and acupuncture for conditions that conventional medicine does not address well, said study co-author Lori Knutson, executive director of the Penny George Institute for Health and Healing with Allina Hospitals and Clinics in Minneapolis. While conventional providers often treat common issues such as back pain with pain medication, holistic providers address root causes, she said.

The researchers used data from the 2007 National Health Interview Survey, analyzing responses from 14,329 working adults. Their findings appear online in the journal Health Services Research.

Among respondents, 1,280 worked in health care and fell into four categories: (1) providers including doctors and nurses; (2) technicians, for instance, sonographers; (3) support workers such as nursing assistants and (4) administrative personnel not providing patient care.

The study looked at practitioner-based CAM, such as acupuncture; self-treatment with CAM, such as practicing Pilates; and any CAM usage such as following a vegetarian diet, meditating and taking certain herbs.

Doctors and nurses had more than twice the odds of having used a practitioner-based CAM method during the prior year and nearly three times the use of self-treatment with CAM than support workers.

“We may be opening Pandora’s box by disclosing utilization of CAM by conventional providers,” Knutson said. “I prefer to believe that this will create an opening for both provider and patient in optimizing health for the whole person.” Knutson added that consumers ought to know that providers use CAM and that health care workers should know that their peers use CAM, although perhaps without discussing it.

How shocked consumers would actually be by their doctors’ use of CAM is questionable, however. The researchers used a broad definition of CAM that includes practices as commonplace as deep breathing, meditation and massage, and ones as complex as biofeedback, hypnosis and chelation therapy, which involves administration of chemicals called chelating agents to eliminate heavy metals such as lead, arsenic or mercury from the body. To discover the depth of doctors’ and nurses’ involvement with the more esoteric approaches will require further research.

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required.

Friday, July 29, 2011

Practicing positive activities may serve as an effective, low-cost treatment for people suffering from depression, according to researchers at the University of California, Riverside and Duke University Medical Center.

In “Delivering Happiness: Translating Positive Psychology Intervention Research for Treating Major and Minor Depressive Disorders,” a paper that appears in the August 2011 issue of the Journal of Alternative and Complementary Medicine, the team of UCR and Duke psychology, neuroscience and psychopharmacology researchers proposed a new approach for treating depression – Positive Activity Interventions (PAI).

PAIs are intentional activities such as performing acts of kindness, practicing optimism, and counting one’s blessing gleaned from decades of research into how happy and unhappy people are different. This new approach has the potential to benefit depressed individuals who don’t respond to pharmacotherapy or are not able or willing to obtain treatment, is less expensive to administer, is relatively less time-consuming and promises to yield rapid improvement of mood symptoms, holds little to no stigma, and carries no side effects.

More than 16 million U.S. adults – about 8 percent of the population – suffer from either major or chronic depression. About 70 percent of reported cases either do not receive the recommended level of treatment or do not get treated at all, according to the National Institute of Mental Health. Globally, the World Health Organization estimates that depression affects more than 100 million people.

Although antidepressants can be lifesaving for some individuals, initial drug therapy produces full benefits in only 30 percent to 40 percent of patients. Even after trying two to four different drugs, one-third of people will remain depressed.

The research team – Kristin Layous and Joseph Chancellor, graduate students at UC Riverside; Sonja Lyubomirsky, professor of psychology and director of the Positive Psychology Laboratory at UC Riverside; and Lihong Wang, M.D., and P. Murali Doraiswamy, M.B.B.S., FRCP, of Duke University – conducted a rigorous review of previous studies of PAIs, including randomized, controlled interventions with thousands of normal men and women as well as functional MRI scans in people with depressive symptoms.

“Over the last several decades, social psychology studies of flourishing individuals who are happy, optimistic and grateful have produced a lot of new information about the benefits of positive activity interventions on mood and well-being,” Lyubomirsky said.

However, such findings have not yet entered mainstream psychiatric practice.

“Very few psychiatrists collaborate with social scientists and no one in my field ever reads the journals where most happiness studies have been published. It was eye-opening for me as a psychopharmacologist to read this literature,” Doraiswamy said.

Lyubomirsky said that after she and Doraiswamy exchanged notes, “the obvious question that popped up was whether we can tap into the PAI research base to design interventions to galvanize clinically depressed people to move past the point of simply not feeling depressed to the point of flourishing.”

Although the paper found that positive activity interventions are effective in teaching individuals ways to increase their positive thinking, positive affect and positive behaviors, only two studies specifically tested these activities in individuals with mild depression.

In one of these studies, lasting improvements were found for six months. Effective PAIs used in the study included writing letters of gratitude, counting one’s blessings, practicing optimism, performing acts of kindness, meditating on positive feelings toward others, and using one’s signature strengths, all of which can be easily implemented into a daily routine at low cost.

People often underestimate the long-term impact of practicing brief, positive activities, Lyubomirsky said. For example, if a person gets 15 minutes of positive emotions from counting her blessings, she may muster the energy to attend the art class she’d long considered attending, and, while in class, might meet a friend who becomes a companion and confidant for years to come. In this way, even momentary positive feelings can build long-term social, psychological, intellectual, and physical skills and reserves.

The researchers’ review of brain imaging studies also led them to theorize that PAIs may act to boost the dampened reward/pleasure circuit mechanisms and reverse apathy – a key benefit that does not usually arise from treatment with medication alone.

“The positive activities themselves aren’t really new,” said Layous, the paper’s lead author. “After all, humans have been counting their blessings, dreaming optimistically, writing thank you notes, and doing acts of kindness for thousands of years. What’s new is the scientific rigor that researchers have applied to measuring benefits and understanding why they work.”

A major benefit of positive activities is that they are simple to practice and inexpensive to deliver.

“If we’re serious about tackling a problem as large as depression, we should be as concerned about the scalability of our solutions as much as their potency,” Chancellor said,

While PAIs appear to be a potentially promising therapy for mild forms of depression,” Doraiswamy cautioned, “they have not yet been fully studied in people with moderate to severe forms of depression. We need further studies before they can be applied to help such patients."

Kim Jobst, a physician and editor-in-chief of the Journal of Alternative and Complimentary Medicine, said the review provides one location in which to reference all relevant PAI findings to date, and includes recommendations that should prove useful to researchers, clinicians and the public. The journal is devoted to publishing research about novel and unconventional treatment approaches.

Tuesday, July 26, 2011

A random-assignment controlled study published today in Mind & Brain, The Journal of Psychiatry (Vol 2, No 1) found improved brain functioning and decreased symptoms of attention-deficit/hyperactivity disorder, ADHD, in students practicing the Transcendental Meditation® (TM) technique. The paper, ADHD, Brain Functioning, and Transcendental Meditation Practice, is the second published study demonstrating TM's ability to help students with attention-related difficulties.

The first exploratory study, published in Current Issues in Education, followed a group of middle school students diagnosed with ADHD who meditated twice a day in school. After 3 months, researchers found over 50% reductions in stress, anxiety, and ADHD symptoms. During the study, a video was made of some students discussing what it felt like to have ADHD, and how those experiences changed after 3 months of regular TM practice.

In this second study, lead author, neuroscientist Fred Travis, PhD, director of the Center for Brain, Consciousness and Cognition, joined principal investigator Sarina J. Grosswald, EdD, a George Washington University-trained cognitive learning specialist, and co-researcher William Stixrud, PhD, a prominent Silver Spring, Maryland, clinical neuropsychologist, to investigate the effects of Transcendental Meditation practice on task performance and brain functioning in 18 ADHD students, ages 11-14 years.

The study was conducted over a period of 6 months in an independent school for children with language-based learning disabilities in Washington, DC. The study showed improved brain functioning, increased brain processing, and improved language-based skills among ADHD students practicing the Transcendental Meditation technique..What was Measured

Students were pretested, randomly assigned to TM or delayed-start comparison groups, and post-tested at 3- and 6-months. Delayed-start students learned TM after the 3-month post-test.

EEG measurements of brain functioning were taken while students were performing a demanding computer-based visual-motor task. Successful performance on the task requires attention, focus, memory, and impulse control.

In addition, students were administered a verbal fluency test. This test measured higher-order executive functions, including initiation, simultaneous processing, and systematic retrieval of knowledge. Performance on this task depends on several fundamental cognitive components, including vocabulary knowledge, spelling, and attention.Theta/Beta Power Ratios and ADHD

Using EEG measurements, the relationship of theta brain waves to beta brain waves can be diagnostic of ADHD. Dr. Joel Lubar of the University of Tennessee has demonstrated that the theta/beta ratio can very accurately identify students with ADHD from those without it.

While theta EEG around 4-5 Hz is commonly associated with daydreaming, drowsiness, and unfocused mental states, theta EEG around 6-8 Hz is seen when one focuses on inner mental tasks, such as memory processing, identifying, and associating.

"In normal individuals, theta activity in the brain during tasks suggests that the brain is blocking out irrelevant information so the person can focus on the task," said Dr. Travis. "But, in individuals with ADHD, the theta activity is even higher, suggesting that the brain is also blocking out relevant information."

And when beta activity, which is associated with focus, is lower than normal," Travis added, "it affects the ability to concentrate on task for extended periods of time.

"Prior research shows ADHD children have slower brain development and a reduced ability to cope with stress," said Dr. Stixrud. "Virtually everyone finds it difficult to pay attention, organize themselves and get things done when they're under stress," he explained. "Stress interferes with the ability to learn—it shuts down the brain. Functions such as attention, memory, organization, and integration are compromised."Why the TM Technique

"We chose the TM technique for this study because studies show that it increases brain function. We wanted to know if it would have a similar effect in the case of ADHD, and if it did, would that also improve the symptoms of ADHD," said Dr. Grosswald.

Dr. Stixrud added, "Because stress significantly compromises attention and all of the key executive functions such as inhibition, working memory, organization, and mental flexibility, it made sense that a technique that can reduce a child's level of stress should also improve his or her cognitive functioning."

The Transcendental Meditation technique is an effortless, easy-to-learn practice, unique among categories of meditation. "TM does not require concentration, controlling the mind or disciplined focus—challenges for anyone with ADHD," Grosswald added.

There is substantial research showing the effectiveness of the TM technique for reducing stress and anxiety, and improving cognitive functioning among the general population. "What's significant about these new findings," Grosswald said, "is that among children who have difficulty with focus and attention, we see the same results. The fact that these children are able to do TM, and do it easily, shows us that this technique may be particularly well-suited for children with ADHD."

Transcendental Meditation produces an experience of restful alertness, which is associated with higher metabolic activity in the frontal and parietal parts of the brain, indicating alertness, along with decreased metabolic activity in the thalamus, which is involved in regulating arousal, and hyperactivity.

With regular practice, this restfully alert brain state, characteristic of the TM technique, becomes more present outside of meditation, allowing ADHD students to attend to tasks. "In a sense," Dr. Travis said, "the repeated experience of the Transcendental Meditation technique trains the brain to function in a style opposite to that of ADHD."

Improved Brain Functioning

During the practice of the Transcendental Meditation technique, coherence is found across different EEG frequencies. After meditation, the brain utilizes this increased functioning ability to support the performance of a task in an integrated manner.

Three months of TM practice resulted in significant decreases in theta/beta ratios and increased verbal fluency. This translates into improved executive function and more efficient cognitive processing.

During the first 3 months of the study, the theta/beta ratios of the control group (delayed start) actually increased. After learning, and practicing TM for 3 months, this group experienced dramatic decreases in theta/beta ratios and increased verbal fluency as well.Student and Parent Surveys

Students reported that the TM technique was enjoyable and easy to do. They felt calmer, less stressed, and better able to concentrate on their schoolwork. They also said they were happier since they started TM. This correlated with reports from the parents.

At the end of the research, the parents completed a questionnaire to assess their perceptions of changes in five ADHD-related symptoms in their children from the beginning to the end of the study. There were positive and statistically significant improvements in the five areas measured: a) Ability to focus on schoolwork, b) Organizational abilities, c) Ability to work independently, d) Happiness, and e) Quality of sleep.Promising Results

The combined results were significant. There was a 48% reduction in the theta/beta power ratios and a 30% increase in brain coherence after the 6-month period. Studies have shown that pharmaceuticals decrease theta/beta power ratios by 3%, and neurofeedback by 25%.

"These are very encouraging findings," said Dr. Stixrud. "Significant improvement in the theta/beta ratio without medication and without having to use any expensive equipment is a big deal, as is significant improvement in student happiness and student academic functioning reported by the parents."

"While stimulant medication is very beneficial for some of my clients with ADHD," Stixrud added, "the number of children who receive great benefit from medicine with minimal side-effects is relatively small. The fact that TM appears to improve attention and executive functions, and significantly reduces stress with no negative side-effects, is clearly very promising." Stixrud said he hoped these findings would lead to more research on the use of TM with children and adolescents.

In conclusion, these findings warrant additional research to assess the impact of Transcendental Meditation practice as a non-drug treatment for ADHD, and to track meditating students' improved academic achievements.

FACT SHEET

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Attention-deficit/hyperactivity disorder (ADHD)—characterized by inattentiveness, impulsivity, and hyperactivity—is diagnosed in almost 10% of children ages 4-17 years, representing 5.4 million children.• The Center for Disease Control and Prevention reported among children with current ADHD, 66.3% were taking medication for the disorder. In total, 4.8% of all children ages 4-17 years (2.7 million) were taking medication for ADHD. The majority of them stay on it into adulthood.• The rate of prescriptions for Attention-Deficit/Hyperactivity Disorder in the U.S. has increased by a factor of five since 1991—with production of ADHD medicines up 2,000 percent in 9 years.• The commonly used drugs for ADHD are stimulants (amphetamines). These drugs can cause persistent and negative side-effects, including sleep disturbances, reduced appetite, weight loss, suppressed growth, and mood disorders. The side-effects are frequently treated with additional medications to manage insomnia or mood swings. Almost none of the medications prescribed for insomnia or mood disturbances are approved by the Food and Drug Administration (FDA) for use with children.• The long-term health effects of ADHD medications are not fully known, but evidence suggests risks of cardiac disorders and sudden death, liver damage and psychiatric events. It has also been found that children on long-term medication have significantly higher rates of delinquency, substance use, and stunted physical growth.• A new study, Study raises questions about long-term effects of ADHD medication, the first of its kind, released February 17, 2010 by the Government of Western Australia's Department of Health, found that "long-term use of drugs such as Ritalin and dexamphetamine may not improve a child's social and emotional well-being or academic performance." The chair of the Ministerial Implementation Committee for Attention Deficit Hyperactivity Disorder in Western Australia said in the Department's press release, "We found that stimulant medication did not significantly improve a child's level of depression, self perception or social functioning and they were more likely to be performing below their age level at school by a factor of 10.5 times."

Tuesday, June 7, 2011

According to the American Cancer Society, more than 11.4 million Americans are currently living with cancer. While cancer treatments are plentiful, many have negative side effects. Previous studies have indicated that a significant number of patients who receive chemotherapy also experience cognitive declines, including decreases in verbal fluency and memory. Now, one University of Missouri health psychologist has found evidence that indicates Tai Chi, a Chinese martial art, might help overcome some of those problems.

"Scientists have known for years that Tai Chi positively impacts physical and emotional health, but this small study also uncovered evidence that it might help cognitive functioning as well," said Stephanie Reid-Arndt, assistant professor and chair of the Department of Health Psychology in the School of Health Professions. "We know this activity can help people with their quality of life in general, and with this new study, we are encouraged about how Tai Chi could also help those who have received chemotherapy. I also hope this encourages more people to think about Tai Chi positively on a broader scale in their lives."

Tai Chi involves practicing slow motion routines and is based on several principles, including mindfulness, breathing awareness, active relaxation and slow movements. The emphasis on slow movement makes Tai Chi particularly suited to a wide range of fitness levels, which makes it very relevant for those who have had chemotherapy and might be experiencing physical limitations as a result, Reid-Arndt said.

The MU pilot study followed a group of women with a history of chemotherapy. The women participated in a 60-minute Tai Chi class two times a week for 10 weeks. The women were tested on memory, language, attention, stress, mood and fatigue before and after the 10-week sessions. According to Reid-Arndt, the results of the tests indicated that the women had made significant improvements in their psychological health and cognitive abilities.

"Tai Chi really helps individuals focus their attention, and this study also demonstrates how good Tai Chi could be for anyone, whether or not they have undergone treatment for cancer," Reid-Arndt said. "Due to the small size of this study, we really need to test a larger group of individuals to gain a better understanding of the specific benefits of this activity for patients who have been treated with chemotherapy and how significant these improvements might be."

###The study was published recently in Complementary Therapies in Clinical Practice.

Monday, June 6, 2011

An Indiana University study that exposed older veterans with stroke to yoga produced promising results as researchers explore whether this popular mind-body practice can help stroke victims cope with their increased risk for painful and even deadly falls.

The pilot study involved 19 men and one woman, average age of 66. For eight weeks, they participated in a twice weekly hour-long group yoga class taught by a yoga therapist who dramatically modified the poses to meet the veterans' needs.

A range of balance items measured by the Berg Balance Scale and Fullerton Advance Balance Scale improved by 17 percent and 34 percent respectively by the end of the program. But equally exciting to lead researcher Arlene A. Schmid, rehabilitation research scientist at the Richard L. Roudebush VA Medical Center in Indianapolis, was the measurable gain in confidence the study participants had in their balance.

"It also was interesting to see how much the men liked it," said Schmid, assistant professor of occupational therapy in the School of Health and Rehabilitation Sciences at Indiana University-Purdue University Indianapolis. Many of the veterans wanted the study to continue or asked for a take-home exercise plan so they could continue the practice. "They enjoyed it so much partly because they weren't getting any other treatment. They had already completed their rehabilitation but felt there still was room for improvement."

Schmid discussed her findings at the American College of Sports Medicine meeting in Denver during her poster presentation, "Preliminary Evidence of Yoga on Balance and Endurance Outcomes for Veterans with Stroke" in the session for Fitness and Performance Testing for Posture, Stability and Balance.

Statistics concerning strokes and falls are grim, with studies showing that strokes can quadruple the risk of falling and greatly increase the risk of breaking a hip after a fall. An estimated 80 percent of people who have strokes will also have some degree of impaired balance.

The study participants performed poses initially while seated in chairs and then progressed to seated and standing poses. Eventually, they all performed poses on the floor, something Schmid considers significant because of a reluctance many older adults have to working on the floor.

"Everything was modified because we wanted them to be successful on day one," Schmid said. "Everyone could be successful at some level."

A score of less than 46 on the Berg Balance Scale indicates a fall risk. Schmid said the study participants on average began the study with a score of 40 and then improved to 47, moving them past the fall risk threshold. The study participants also showed significant improvements in endurance based on a seated two-minute step test and a six-minute walk test.

Schmid said research into therapeutic uses for yoga is "really taking off," particularly in mental health fields. Clinically, she has been watching a small trend of occupational therapists and physical therapists also becoming yoga therapists. The yoga performed in the study was modified to the extent that Schmid said it would be very difficult to find a comparable class offered publicly. Such a class should be taught by a yoga therapist who has had additional training in anatomy and physiology and how to work with people with disabilities. Schmid hopes to expand the study so she and her colleagues can explore whether such classes are effective on a larger scale.

Wednesday, June 1, 2011

Veterans of the Iraq/Afghanistan wars showed a 50 percent reduction in their symptoms of post-traumatic stress disorder (PTSD) after just eight weeks of practicing the stress-reducing Transcendental Meditation technique, according to a pilot study published in the June 2011 issue of Military Medicine (Volume 176, Number 6).

The study evaluated five veterans, ages 25- to 40-years-old, who had served in Iraq, Afghanistan or both from 10 months to two years involving moderate or heavy moderate combat.

The study found that Transcendental Meditation produced significant reductions in stress and depression, and marked improvements in relationships and overall quality of life. Furthermore, the authors reported that the technique was easy to perform and was well accepted by the veterans.

The Clinician Administered PTSD Scale (CAPS) was the primary measure for assessing the effectiveness of TM practice on PTSD symptoms. CAPS is considered by the Department of Veterans Affairs as the "gold standard" for PTSD assessment and diagnosis for both military Veteran and civilian trauma survivors.

The paper's senior researcher, Norman Rosenthal, M.D., is clinical professor of psychiatry at George

"Even though the number of veterans in this study was small, the results were very impressive," Rosenthal said. "These young men were in extreme distress as a direct result of trauma suffered during combat, and the simple and effortless Transcendental Meditation technique literally transformed their lives."

The findings were similar to those from a randomized controlled study of Vietnam veterans conducted by researchers at the University of Colorado School of Medicine. In that study, published in the Journal of Counseling and Development in 1985, after three months of twice-daily TM practice, the veterans had fewer symptoms than those receiving conventional psychotherapy of the day. In fact, most of the TM-treated subjects required no further treatment.

"Even though the combat experiences of OEF/OIF veterans and Vietnam veterans are quite different, the fact that our study corroborates the results of the previous study tells us that this technique has the potential to be an effective tool against PTSD and combat stress, regardless of combat situation," explained Sarina Grosswald, EdD, co-researcher on the study.

Rosenthal hypothesizes that Transcendental Meditation helps people with PTSD because regular practice produces long-term changes in sympathetic nervous system activity, as evidenced by decreased blood pressure, and lower reactivity to stress. "Transcendental Meditation quiets down the nervous system, and slows down the 'fight-or-flight' response," he said. People with PTSD show overactive fight-or-flight responses, making them excellent candidates for Transcendental Meditation.

Rosenthal points out that there is an urgent need to find effective and cost-effective treatments for veterans with combat-related PTSD. "The condition is common, affecting an estimated one in seven deployed soldiers and Marines, most of whom do not get adequate treatment. So far, only one treatment—simulation exposure to battleground scenes—has been deemed effective, but it requires specialized software and hardware, trained personnel and is labor intensive.

A new report paints a stark picture of the toll on the U.S. military of almost a decade of war: higher stress and lower morale. The report, released Thursday, May 19, 2011, at the Pentagon, relied on questions to soldiers and Marines in Afghanistan in July and August of last year and compared responses with similar surveys in 2005 and 2009. The report noted "significant decline in reports of individual morale" as well as "acute stress rates significantly higher" than in earlier years. Source: CNN: New Pentagon study finds psychological toll from years of fighting.

"Research suggests that 18% to 30% of Vietnam veterans, 10% to 20% of Iraq War veterans, and 5% to 15% of Gulf War veterans have experienced PTSD," says U.S. Army Colonel Charles C Engel, Director of Deployment Health Clinical Center. Source: Britannica Blog: PTSD in War Veterans: 5 Questions for Psychiatrist and U.S. Army Col. Charles C. Engel.

A May 8, 2008 report said the number of suicides among veterans of wars in Iraq and Afghanistan may exceed the combat death toll because of inadequate mental health care, the U.S. government's top psychiatric researcher said. Source: Bloomberg: Post-War Suicides May Exceed Combat Deaths, U.S. Says (Update1).

VA's suicide hotline receives 10,000 calls per month from active and retired servicemen. There are 950 suicide attempts per month by veterans receiving care from the VA. 18 veterans commit suicide each day, 5 of them are under the care of the VA. Source: Army Times: 18 veterans commit suicide each day.

Every night, an estimated 63,000 veterans lay down to sleep in a county jail. Source: Syracuse.com: The Post-Standard: Syracuse VA Medical Center visits county jails, searches for military veterans who need assistance.

Each night, 107,000 veterans find their home on the street. Source: National Coalition for Homeless Veterans.

27% of returning OEF/OIF veterans meet criteria for alcohol abuse. Of returning soldiers, 20% of active duty and 42% of reservists are in need of mental health treatment. Source: NIDA: A Research Update from the National Institute on Drug Abuse.The Rand Corporation's study "Invisible Wounds of War" revealed a disturbing truth about the health of our military as recently as 2008: Over 300,000 returning veterans from Iraq and Afghanistan suffer from PTSD or major depression. According to the Rand report, these "invisible wounds" take a high toll—impacting veterans' quality of life, hindering their performance at work, straining their families, and placing them at greater risk for violent and self-destructive behaviors. The economic cost of these disorders is equally great—reaching as high as $6 billion over 2 years. Yet, despite the heavy toll of PTSD and depression, only half of affected veterans seek care, and only a third of those who do, receive adequate treatment. Thus, over 80% of affected veterans remain without needed help.

Since October 31, 2007, over 1.6 million troops have been deployed in Iraq and Afghanistan. According to the Rand Corporation's study, 225,000 of the returning troops suffer from PTSD, 226,000 are diagnosed with major depression, and 303,000 develop either illness. Source: Rand Corporation: Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, 2008.The Transcendental Meditation Technique

The Transcendental Meditation technique is an effortless technique practiced 10-20 minutes twice a day sitting comfortably with the eyes closed.

TM is not a religion or philosophy and involves no new beliefs or change in lifestyle.Over 350 peer-reviewed research studies on the TM technique confirm a range of benefits for mind, body and behavior.

Several studies have compared the effects of different meditation practices and found that Transcendental Meditation provides deeper relaxation and is more effective at reducing anxiety, depression and hypertension than other forms of meditation and relaxation. In addition, no other meditation practice shows the widespread coherence throughout all areas of the brain that is seen with Transcendental Meditation.The Transcendental Meditation technique is taught in the United States by a non-profit, educational organization.

Tuesday, May 31, 2011

Attending frequently with medically unexplained symptoms is distressing for both patient and doctor and effective treatment or management options are limited: one in five patients have symptoms that remain unexplained by conventional medicine. Studies have shown that the cost to the NHS of managing the treatment of a patient with medically unexplained symptoms can be twice that of a patient with a diagnosis.

A research team from the Institute of Health Services Research, Peninsula Medical School, University of Exeter, has carried out a randomised control trial and a linked interview study regarding 80 such patients from GP practices across London, to investigate their experiences of having five-element acupuncture added to their usual care. This is the first trial of traditional acupuncture for people with unexplained symptoms.

The results of the research are published in the British Journal of General Practice. They reveal that acupuncture had a significant and sustained benefit for these patients and consequently acupuncture could be safely added to the therapies used by practitioners when treating frequently attending patients with medically unexplained symptoms.

The patient group was made up of 80 adults, 80 per cent female with an average age of 50 years and from a variety of ethnic backgrounds who had consulted their GP at least eight times in the past year. Nearly 60 per cent reported musculoskeletal health problems, of which almost two-thirds had been present for a year.

In the three months before taking part in the study, the 80 patients had accounted for the following NHS experiences: 21 patient in-days; 106 outpatient clinic visits; 52 hospital clinic visits (for treatments such as physiotherapy, chiropody and counselling); 44 hospital visits for investigations (including 10 magnetic resonance imaging – MRI – scans); and 75 visits to non-NHS practitioners such as opticians, dentists and complementary therapists.

The patients were randomly divided into an acupuncture group and a control group. Eight acupuncturists administered individual five-element acupuncture to the acupuncture group immediately, up to 12 sessions over 26 weeks. The same numbers of treatments were made available to the control group after 26 weeks.

At 26 weeks the patients were asked to complete a number of questionnaires including the individualised health status questionnaire "Measure Yourself Medical Outcome Profile."

The acupuncture group registered a significantly improved overall score when compared with the control group. They also recorded improved wellbeing but did not show any change in GP and other clinical visits and the number of medications they were taking. Between 26 and 52 weeks the acupuncture group maintained their improvement and the control group, now receiving their acupuncture treatments, showed a 'catch up' improvement.

The associated qualitative study, which focused on the patients' experiences, supported the quantitative work.

This element identified that the participating patients had a variety of longstanding symptoms and disability including chronic pain, fatigue and emotional problems which affected their ability to work, socialise and carry out everyday tasks. A lack of a convincing diagnosis to explain their symptoms led to frustration, worry and low mood.

Participating patients reported that their acupuncture consultations became increasingly valuable. They appreciated the amount of time they had with each acupuncturist and the interactive and holistic nature of the sessions – there was a sense that the practitioners were listening to their concerns and, via therapy, doing something positive about them.

As a result, many patients were encouraged to take an active role in their treatment, resulting in cognitive and behavioural lifestyle changes, such as: a new self-awareness about what caused stress in their lives, and a subsequent ability to deal with stress more effectively; and taking their own initiatives based on advice from the acupuncturists about diet, exercise, relaxation and social activities.

Comments from participating patients included: "the energy is the main thing I have noticed. You know, yeah, it's marvellous! Where I was going out and cutting my grass, now I'm going out and cutting my neighbour's after because he's elderly"; "I had to reduce my medication. That's the big help actually, because medication was giving me more trouble…side effects"; and "It kind of boosts you, somehow or another."

Dr. Charlotte Paterson, who managed the randomised control trial and the longitudinal study of patients' experiences, commented: "Our research indicates that the addition of up to 12 five-element acupuncture consultations to the usual care experienced by the patients in the trial was feasible and acceptable and resulted in improved overall well-being that was sustained for up to a year.

"This is the first trial to investigate the effectiveness of acupuncture treatment to those with unexplained symptoms, and the next development will be to carry out a cost-effectiveness study with a longer follow-up period. While further studies are required, this particular study suggests that GPs may recommend a series of five-element acupuncture consultations to patients with unexplained symptoms as a safe and potentially effective intervention."

She added: "Such intervention could not only result in potential resource savings for the NHS, but would also improve the quality of life for a group of patients for whom traditional biomedicine has little in the way of effective diagnosis and treatment."

Thursday, April 21, 2011

Acupuncture provides long-lasting relief to hot flashes, heart palpitations and anxiety due to side effects of the hormone given to counteract testosterone, the hormone that induces prostate cancer, according to a study published in the April issue of the International Journal of Radiation Oncology•Biology•Physics, an official journal of the American Society for Radiation Oncology (ASTRO).

The main treatments for men with metastatic prostate cancer are either surgery or hormone therapy to significantly reduce the level of testosterone in the body. Eliminating testosterone has been proven to keep the cancer in check by starving the cancer of hormones it needs to grow and spread. However, about half of the time, this therapy also causes very uncomfortable hot flashes similar to those women experience during menopause. The main way to combat hot flashes is to take antidepressants, but these drugs can cause side effects of their own, including nausea, dry mouth, sleeplessness, altered appetite and sexual changes.

In a prospective study conducted in the department of radiation oncology and the acupuncture section of New York Methodist Hospital and Weill Cornell Medical College of Cornell University, both in New York, researchers evaluated 14 men who were experiencing hot flashes due to hormone therapy for prostate cancer. Upon enrolling in the study, the men were given a hot flash score (HFS) to evaluate their discomfort from daily hot flashes. The mean initial HFS was 28.3.

Participants then received acupuncture twice a week for 30 minutes at a time for four weeks. Two weeks after receiving acupuncture, their HFS was measured again and had dropped more than half to 10.3. At six weeks post-treatment, their HFS was 7.5. After eight months, the men were evaluated again and their mean HFS was 7. "Our study shows that physicians and patients have an additional treatment for something that affects many men undergoing prostate cancer treatment and actually has long-term benefits, as opposed to more side effects," Hani Ashamalla, M.D., lead author of the study and a radiation oncologist at New York Methodist Hospital, said. "We are now designing a randomized clinical trial to further evaluate acupuncture after prostate cancer treatment. I encourage men suffering this symptom to talk to their doctors about enrolling."

Thursday, March 3, 2011

A new University of Colorado Boulder study indicates an ancient form of complementary medicine may be effective in helping to treat people with mild traumatic brain injury, a finding that may have implications for some U.S. war veterans returning home.

The study involved a treatment known as acupressure in which one's fingertips are used to stimulate particular points on a person's body -- points similar to those stimulated with needles in standard acupuncture treatments, said CU-Boulder Professor Theresa Hernandez, lead study author. The results indicate a link between the acupressure treatments and enhanced cognitive function in study subjects with mild traumatic brain injury, or TBI.

"We found that the study subjects with mild traumatic brain injury who were treated with acupressure showed improved cognitive function, scoring significantly better on tests of working memory when compared to the TBI subjects in the placebo control group," said Hernandez, a professor in CU-Boulder's psychology and neuroscience department. "This suggests to us that acupressure could be an effective adjunct therapy for those suffering from TBI."

The acupressure treatment type used in the study is called Jin Shin. For the study, Hernandez and her colleagues targeted the 26 points on the human body used in standard Jin Shin treatments ranging from the head to the feet. The study subjects all received treatments by trained Jin Shin practitioners.

According to practitioners, Jin Shin acupressure points are found along "meridians" running through the body that are associated with specific energy pathways. It is believed that each point is tied to the health of specific body organs, as well as the entire body and brain, Hernandez said.

"Think of the meridians as freeways and the pressure points as towns along the way," she said. "When there is a traffic jam in Denver that causes adverse effects as far away as Boulder, clearing the energy blocks, or in this case traffic jams, helps improve flow and overall health."

The study involved 38 study subjects, each of whom was randomly assigned to one of two groups -- an experimental group that received active acupressure treatments from trained experts and a control group that received treatments from the same experts on places on the body that are not considered to be acupressure points, acting as a placebo. The study was "blinded," meaning the researchers collecting data and the study participants themselves did not know who was in the experimental group or the placebo group until the end of the study.

The team used a standard battery of neuropsychological tests to assess the results. In one test known as the Digit Span Test, subjects were asked to repeat strings of numbers after hearing them, in both forward and backward order, to see how many digits they could recall. Those subjects receiving active acupressure treatments showed increased memory function, said Hernandez.

A second standard psychology test used for the study, called the Stroop Task, measured working memory and attention. The test subjects were shown the names of colors like blue, green or red on a computer screen. When the names of the particular colors are viewed on the screen in a different color of ink -- like the word "green" spelled out in blue ink -- test subjects take longer to name the ink color and the results are more error-prone, according to Hernandez. The Stroop Test subjects in the CU-Boulder study wore special caps wired with electrodes to measure the brain activity tied to specific stimuli. The results showed those who received the active acupressure treatments responded to stimuli more rapidly than those who received the placebo treatments, Hernandez said.

"We were looking at synchronized neural activity in response to a stimulus, and our data suggest the brains of those in the active acupressure group responded differently when compared to those in the placebo acupressure group," she said.

A paper on the subject was published in the January issue of the Journal of Neurotrauma, a peer-reviewed publication on the latest advances in both clinical and laboratory investigations of traumatic brain and spinal cord injury. Co-authors on the study included CU-Boulder's Kristina McFadden, Kyle Healy, Miranda Dettman, Jesse Kaye and Associate Professor Tiffany Ito of psychology and neuroscience.

Funded by the Colorado Traumatic Brain Injury Trust Fund, the study is believed to be one of the first placebo-controlled studies ever published in a peer-reviewed medical journal showing the benefit of acupressure to treat patients with TBI, Hernandez said.

"We would like to see if the Jin Shin treatment is useful to military veterans returning home with traumatic brain injury, a signature wound prevalent in the wars in Iraq and Afghanistan," said Hernandez. The Jin Shin acupressure treatment can be taught to family and friends of those with TBI and can even be used as a self-treatment, which could allow for more independence, she said.

In a 2010 stroke study led by Hernandez, the researchers concluded that Jin Shin acupressure triggered a larger and faster relaxation response during active treatments and a decreased stress response following active treatments compared with what was seen in placebo treatments. Hernandez and her colleagues are embarking on a new study on the use of Jin Shin acupressure in athletes to see if the enhanced relaxation response and decreased stress seen in the stroke study can reduce the likelihood of athletic injury.

In 2002, Hernandez partnered with former Colorado Rep. Todd Saliman to initiate the Colorado Traumatic Brain Injury Trust Fund, a statute that has generated nearly $2 million to the state annually since 2004 from surcharges to traffic offenses like driving while impaired and speeding. Roughly 65 percent of the money goes toward rehabilitation and care services for individuals with TBI, about 30 percent goes for TBI research and 5 percent for TBI education. Because of the statute, nearly 4,000 Colorado citizens with TBI have received care and rehabilitation services for brain injuries.

Monday, February 21, 2011

Complementary and alternative medicine (CAM), as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of different medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. Conventional medicine is medicine that is practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by health professionals who work with them, including physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.[1]

This summary answers some frequently asked questions about the use of CAM therapies among the general public and about how CAM therapies are evaluated, and suggests sources for more information. 2. What is integrative medicine?

NCCAM defines integrative medicine as treatment that combines conventional medicine with CAM therapies that have been reported to be safe and effective after being studied in patients. In practice, many CAM therapies used in along with conventional medicine have not yet been well tested. 3. Are complementary and alternative therapies widely used?

Yes. Many CAM approaches are used by a large percentage of people in the general public and cancer patients.

The 2007 National Health Interview Survey reported about 4 out of 10 adults used CAM therapy in the past 12 months, with the most commonly used treatments being natural products and deep breathing exercises.[2]

One large survey of cancer survivors reported on the use of complementary therapies.[3] The therapies used most often were prayer and spiritual practice (61%), relaxation (44%), faith and spiritual healing (42%), and nutritional supplements and vitamins (40%). CAM therapies are used by 31-84% of children with cancer, both in and outside of clinical trials.[4] CAM therapies have been used in the management of side effects caused by cancer or cancer treatment. 4. How are CAM approaches evaluated?

It is important that CAM therapies be evaluated with the same long and careful research process used to evaluate conventional treatments. The National Cancer Institute (NCI) and the Office of Cancer Complementary and Alternative Medicine (OCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer. A listing of these trials is available at the OCCAM Clinical Trials Web page.

Conventional cancer treatments have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of many CAM therapies. Research of CAM therapies has been slower for a number of reasons: * Time and funding issues. * Problems finding institutions and cancer researchers to work with on the studies. * Regulatory issues.

Some CAM therapies have undergone careful evaluation. A small number of CAM therapies originally meant to be alternative treatments are finding a place in cancer treatment as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997,[5] acupuncture has been found to be effective in the management of chemotherapy -associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or possibly harmful. 5. What is the NCI Best Case Series Program?

The NCI Best Case Series Program, which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches that warrant NCI-initiated research. 6. Are NCI and NCCAM sponsoring clinical trials in complementary and alternative medicine?

NCI and NCCAM are currently sponsoring or cosponsoring various clinical trials to study complementary and alternative treatments for cancer. Some of these trials study the effects of complementary approaches used in addition to conventional treatments, while others compare alternative therapies with conventional treatments. Current trials include the following: * Electroacupuncture to treat delayed chemotherapy -induced nausea and vomiting in patients diagnosed with pediatric sarcoma, neuroblastoma, nasopharyngeal carcinoma, germ cell tumors, or Hodgkin lymphoma (NCT00040911).

* Flaxseed in postmenopausal women with hot flashes with a history of cancer (NCT00956813).

* Reiki/energy healing in prostate cancer patients (NCT00065208).

* Yoga for fatigue in breast cancer survivors (NCT00727662).

Patients who are interested in taking part in these or any clinical trials should talk with their doctor.

Several clinical trials databases offer patients, family members, and health professionals information about research studies that use CAM. Clinical trials can be found by searching the following: * The NCI’s PDQ Clinical Trials Database, which can be searched by using criteria such as cancer type, type of trial, geographic region, trial sponsorship, and/or drug name. This information is also available by calling the NCI’s Cancer Information Service (1–800–4–CANCER [1–800–422–6237]; TTY: 1–800–332–8615).

* The NCCAM Clinical Trials Web page, which can be searched by the type of treatment or disease.

* The Clinical Trials.Gov Web page, which can be searched by the type of medical condition or intervention.

7. What should patients do when using or considering complementary and alternative therapies?

Cancer patients using or considering complementary or alternative therapy should discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. Some resources for this information are provided in Question 9. 8. When considering complementary and alternative therapies, what questions should patients ask their health care providers? * What benefits can be expected from this therapy? * What are the risks associated with this therapy? * Do the known benefits outweigh the risks? * What side effects can be expected? * Will the therapy interfere with conventional treatment? * Is this therapy part of a clinical trial? If so, who is sponsoring the trial? * Will the therapy be covered by health insurance?

Further information on evaluating CAM therapies and practitioners is available from NCCAM. 9. What federal agencies can provide more information about CAM therapies?

Patients, their families, and their health care providers can learn about CAM therapies from the following government agencies and resources:

NCCAM * NCCAM is the federal government’s lead agency for scientific research on CAM. NCCAM is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.

* The NCCAM Clearinghouse provides information on NCCAM and on CAM, including fact sheets, other publications, and searches of federal databases of scientific and medical literature. Publications include the following: o Are You Considering CAM? o Selecting a CAM Practitioner o Paying for CAM Treatment

* The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

NCI's OCCAM coordinates the activities of NCI in the area of complementary and alternative medicine. OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public on the NCI Web site.

* NCI Cancer Information Service

U.S. residents may call the NCI Cancer Information Service toll free at 1–800–4–CANCER (1–800–422–6237) Monday through Friday from 9:00 am to 4:30 pm EST. Deaf and hearing-impaired callers with TTY equipment may call 1–800–332–8615. A trained Cancer Information Specialist is available to answer your questions.

* PDQ

NCI’s PDQ, a comprehensive cancer information database, contains peer-reviewed summaries of the latest information about the use of CAM in the treatment of cancer. Each summary contains background information about the specific treatment, a brief history of its development, information about relevant research studies, and a glossary of scientific and medical terms. CAM summaries can be found on NCI's Web site.

U.S. Food and Drug Administration (FDA)

The FDA regulates drugs and medical devices to ensure that they are safe and effective. This agency provides a number of publications for consumers, including information about dietary supplements.

CAM on PubMed, a database accessible via the Internet, was developed jointly by NCCAM and the NIH National Library of Medicine (NLM). It contains bibliographic citations (from 1966 to the present) to articles on CAM published in scientifically based, peer-reviewed journals. These citations are a subset of NLM's PubMed system, which contains more than 11 million journal citations from the MEDLINE database and additional life science journals important to health researchers, practitioners, and consumers. CAM on PubMed also displays links to many publisher Web sites, which may offer the full text of articles.